Regenerated hair cells become functional during continuous administration of kanamycin

Mechanisms of rapid sensory hair-cell death following co-administration of gentamicin and ethacrynic acid

Concurrent administration of a high dose of gentamicin (GM; 125mg/kg IM) and ethacrynic acid (EA; 40mg/kg IV) results in rapid destruction of virtually all cochlear hair cells; however, the cell death signaling pathways underlying this rapid form of hair-cell degeneration are unclear. To elucidate the mechanisms underlying GM/EA-mediated cell death, several key cell death markers were assessed in the chinchilla cochlea during the early stages of degeneration. In the middle and basal turns of the cochlea, massive hair-cell loss including destruction of the stereocilia and cuticular plate occurred 12h after GM/EA treatment. Condensation and fragmentation of outer hair-cell nuclei, morphological features of apoptosis, were first observed 5-6h post-treatment in the basal turn of the cochlea. Metabolic function, reflected by succinate dehydrogenase histochemistry and mitochondrial staining, decreased significantly in the basal turn 4h following GM/EA treatment; these early changes were accompanied by the release of cytochrome c from the mitochondria into the cytosol and intense expression of initiator caspase-9 and effector caspase-3. GM/EA failed to induce expression of extrinsic initiator caspase-8. These results suggest that the rapid loss of hair cells following GM/EA treatment involves cell death pathways mediated by mitochondrial dysfunction leading to the release of cytochrome c, activation of initiator caspase-9 and effector caspase-3.

Hair cell regeneration: winging our way towards a sound future

The discovery of hair cell regeneration in the inner ear of birds provides new optimism that there may be a treatment for hearing and balance disorders. In this review we describe the process of hair cell regeneration in birds; including restoration of function, recovery of perception and what is currently known about molecular events, such as growth factors and signalling systems. We examine some of the key recent findings in both birds and mammals.

Leupeptin protects cochlear and vestibular hair cells from gentamicin ototoxicity

Calpains, a family of calcium-activated proteases that breakdown proteins, kinases, phosphatases and transcription factors, can promote cell death. Since leupeptin, a calpain inhibitor, protected against hair cell loss from acoustic overstimulation, we hypothesized that it might protect cochlear and vestibular hair cells against gentamicin (GM) ototoxicity. To test this hypothesis, mouse organotypic cultures from the cochlea, maculae of the utricle and the crista of the semicircular canal (P1-P3) were treated with different doses of GM (0.1-3 mM) alone or in the presence of leupeptin (0.1-3 mM). The percentage of outer hair cells (OHCs) and inner hair cells (IHCs) decreased with increasing doses of GM between 0.1 and 3 mM. The addition of 1 mM of leupeptin significantly reduced GM-induced damage to IHCs and OHCs; this protective effect was dose-dependent. GM also significantly reduced hair cell density in the crista and utricle in a dose-dependent manner between 0.1 and 3 mM. The addition of 1 mM of leupeptin significantly reduced hair cell loss in the crista and utricle for GM concentrations between 0.1 and 3 mM. These results suggest that one of the early steps in GM ototoxicity may involve calcium-activated proteases that lead to the demise of cochlear and vestibular hair cells.

Structural recovery from sound and aminoglycoside damage in the avian cochlea

Hair cell regeneration in the mature avian cochlea occurs in response to trauma that causes the death of some or all of the existing hair cell population. In general, this trauma has been introduced experimentally by either sound overexposure or treatment of the bird with high doses of aminoglycoside antibiotics. When injured hair cells are ejected from the sensory epithelium, the nonsensory supporting cells respond by re-entering the cell cycle and proliferating or by transdifferentiating directly into hair cells without a mitotic event. The new hair cells mature in a manner similar to that seen during embryonic development. They make connections with the overlying tectorial membrane and the afferent and efferent cochlear nerve processes within the sensory epithelium. This structural regeneration is accompanied by a significant recovery of auditory function and thus allows the animal to regain its hearing ability. This hair cell regeneration is presumably quite beneficial to birds, whose primary means of communication is based on vocalizations and the ability to hear and comprehend them. The prevalence of hearing loss in our society and the isolating impact it has on affected individuals makes the potential for finding ways to induce a similar hair cell regeneration in humans a very tempting goal. Studies of hair cell regeneration over the last 12 years have focused on the mechanisms that regulate the process and how they could be controlled. This review will examine the structural events involved in regenerating hair cells in the avian cochlea after sound damage and aminoglycoside treatment. It will define how hair cells and nerve endings are lost and the tectorial membrane is damaged by the traumatizing stimuli and how the supporting cells and nerve fibers respond by producing new hair cells, a new tectorial membrane and new synaptic connections during recovery. Finally, it will focus on mechanisms that control the proliferation and transdifferentiation of supporting cells and the differentiation of new hair cells. This structural review is accompanied by a companion review that covers the fundamental issues concerning functional recovery in the avian cochlea associated with hair cell regeneration.

Functional recovery in the avian ear after hair cell regeneration

Trauma to the inner ear in birds, due to acoustic overstimulation or ototoxic aminoglycosides, can lead to hair cell loss which is followed by regeneration of new hair cells. These processes are paralleled by hearing loss followed by significant functional recovery. After acoustic trauma, functional recovery is rapid and nearly complete. The early and major part of functional recovery after sound trauma occurs before regenerated hair cells become functional. Even very intense sound trauma causes loss of only a proportion of the hair cell population, mainly so-called short hair cells residing on the abneural mobile part of the avian basilar membrane. Uncoupling of the tectorial membrane from the hair cells during sound overexposure may serve as a protection mechanism. The rapid functional recovery after sound trauma appears not to be associated with regeneration of the lost hair cells, but with repair processes involving the surviving hair cells. Small residual functional deficits after recovery are most likely associated with the missing upper fibrous layer of the tectorial membrane which fails to regenerate after sound trauma. After aminoglycoside trauma, functional recovery is slower and parallels the structural regeneration more closely. Aminoglycosides cause damage to both types of hair cells, starting at the basal (high frequency) part of the basilar papilla. However, functional hearing loss and recovery also occur at lower frequencies, associated with areas of the papilla where hair cells survive. Functional recovery in these low frequency areas is complete, whereas functional recovery in high frequency areas with complete hair cell loss is incomplete, despite regeneration of the hair cells. Permanent residual functional deficits remain. This indicates that in low frequency regions functional recovery after aminoglycosides involves repair of nonlethal injury to hair cells and/or hair cell-neural synapses. In the high frequency regions functional recovery involves regenerated hair cells. The permanent functional deficits after the regeneration process in these areas are most likely associated with functional deficits in the regenerated hair cells or shortcomings in the synaptic reconnections of nerve fibers with the regenerated hair cells. In conclusion, the avian inner ear appears to be much more resistant to trauma than the mammalian ear and possesses a considerable capacity for functional recovery based on repair processes along with its capacity to regenerate hair cells. The functional recovery in areas with regenerated hair cells is considerable but incomplete.